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The formation of porous crystalline structures of a series of Zr-MOFs comprising two coligands (dimethyl-terphenylene and diphenylanthracene dicarboxylates, TP and DPA, respectively) with varying ratios offered the opportunity to investigate systematically the modulation of the accessible pore volumes. These MOF structures exhibit large octahedral cavities of common diameter, while the tetrahedral cavity sizes vary in the series and are gradually reduced with increasing anthracene-based ligand. At low loadings, xenon atoms concentrate in the most energetically favorable corners of the tetrahedral cavities. The application of multiple investigation techniques, such as synchrotron-radiation X-ray diffraction of Xe-loaded crystalline powders, Xe adsorption isotherms, and grand canonical Monte Carlo (GCMC) simulations, allows for determining gas location and interaction energy with the pore walls. The remarkable Xe adsorption energy of 25.4 kJ/mol at low coverage was obtained for the more effective confinement-sites of homoligand Zr-DPA. Additionally, hyperpolarized 129Xe NMR chemical shifts, collected at very low Xe partial pressure (2% Xe dilution), increased from 78.5 to 94.0 ppm, with increasing DPA ligand content. GCMC sorption simulations of the gas mixture with the same composition as that used for the hyperpolarized NMR experiments show remarkable Xe capture and 99% Xe located in the tetrahedral corners. more...

The High Voltage Padova Test Facility (HVPTF) is an experimental device for investigating high voltage (HV) Direct Current insulation in a vacuum, in support of the development of the prototype of a neutral beam injector for ITER, named MITICA. Inside a high vacuum environment, two stainless steel electrodes, spaced by a few centimeters gap, can achieve a voltage difference of up to 800 kV. During the electrode conditioning process, small current bursts, known as micro-discharges (MDs) occur, accompanied by the emission of X-rays, and of an overall increase in gas emission measurement. This study focuses on the fine dynamics of the MD phenomenon measured by the current signal and by the X-ray detectors, in an attempt to provide a possible physical interpretation of this mechanism. In particular, it appears that the MD fine dynamics are related to the growing asymmetry between the MD current values collected by the anode and cathode, observed during the electrode conditioning. The role of the vacuum chamber, acting as a third electrode, is investigated by an updated toy model, which evaluates the different current contributions collected from the two polarized electrodes, particularly those generated by secondary electron (SE) emission. The ratio of anode to cathode currents computed by the toy model closely matches the experimental one. Further experimental observations supporting the hypothesis of anode gas emission and expansion are discussed. Finally, a first study about the statistical distribution of the time intervals between successive MD suggests the occurrence of almost two different trigger mechanisms, evolving during the electrode conditioning process. more...

Despite being recognized as a preventable serious adverse event more than a century ago, Unintentionally Retained Foreign Objects (URFOs) continue to occur. They, in fact, remain the second most common Sentinel Event (SE) reported to The Joint Commission (TJC).A large private Hospital, after many years of URFO-free practice, experienced four (4) cases of URFOs during a 12-month period (March 9, 2021–March 4, 2022). Three cases occurred in the Operating Room (OR), and one case occurred in Labor & Delivery. All four cases involved the abdomen. The URFO was a sponge in two cases, a retractor wrapped in a pad in one case, and a surgical specimen in one case. Our review confirmed that the characteristics of our cases were similar to those reported by the Joint Commission. The main contributing factor was the closure of the wound without performing the sponge/instrument count. This safety breach resulted from a combination of factors: the inexperience of the nursing staff caused by a dramatic 40% turnover during the pandemic, the lack of assigned responsibility to perform the counting, and the willingness of the surgeon to skip the count. To address the main factors, we implemented a multipronged approach that includes the following: standardization of the protocols of sponge counting, hand-off with shift change, and of double surgical team involvement; assignment of the counting responsibility to two nurses; and education of the new nurses and of independent practitioners about the OR procedures with monitoring of correct implementation. more...

and boros, from bora, which in Greek means food, as in tail food, which is strange because usually food is thought of as something other than self, but the larger [...]

In Malaysia, there is still a lack of awareness of the impacts of construction and demolition (C&D) wastes to the environment despite the robust growth of the construction industry. This study was conducted to identify the most suitable waste minimisation strategies to be adopted throughout the construction cycles via obtaining views from the expert panels. A three rounds of Delphi technique were conducted; in which the analytical hierarchy process (AHP) was incorporated in the second round. Experts' opinions of government agencies, developers, consultants and contractors were gathered to carry out this study. The results reveal that there is needs to integrate the principles of reduce, reuseand recycleat each stage of the construction cycles. Furthermore, it was observed that the most fitting waste minimisation strategies that can be used throughout the construction cycle are modern construction modern, improving and tightening regulation and improve site management. Consequently, a conceptual framework of C&D waste management has been developed based on the inputs from the study. more...

International guidelines exclude from surgery patients with peritoneal carcinosis of colorectal origin and a peritoneal cancer index (PCI) ≥ 16. This study aims to analyze the outcomes of patients with colorectal peritoneal carcinosis and PCI greater or equal to 16 treated with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) (CRS + HIPEC). We retrospectively performed a multicenter observational study involving three Italian institutions, namely the IRCCS Policlinico San Matteo in Pavia, the M. Bufalini Hospital in Cesena, and the ASST Papa Giovanni XXIII Hospital in Bergamo. The study included all patients undergoing CRS + HIPEC for peritoneal carcinosis from colorectal origin from November 2011 to June 2022. The study included 71 patients: 56 with PCI < 16 and 15 with PCI ≥ 16. Patients with higher PCI had longer operative times and a statistically significant higher rate of not complete cytoreduction, with a Completeness of Cytoreduction score (CC) 1 (microscopical disease) of 30.8% (p= 0.004). The 2-year OS was 81% for PCI < 16 and 37% for PCI ≥ 16 (p< 0.001). The 2-years DFS was 29% for PCI < 16 and 0% for PCI ≥ 16 (p< 0.001). The 2-year peritoneal DFS for patients with PCI < 16 was 48%, and for patients with PCI ≥ 16 was 57% (p= 0.783). CRS and HIPEC provide reasonable local disease control for patients with carcinosis of colorectal origin and PCI ≥ 16. Such results form the basis for new studies to reassess the exclusion of these patients, as set out in the current guidelines, from CRS and HIPEC. This therapy, combined with new therapeutical strategies, i.e., pressurized intraperitoneal aerosol chemotherapy (PIPAC), could offer reasonable local control of the disease, preventing local complications. As a result, it increases the patient’s chances of receiving chemotherapy to improve the systemic control of the disease. more...

Two compact generators of 14 and 2.5 MeV neutrons have been installed in the new Neutron Irradiation Laboratory for Electronics (NILE) facility. Neutrons are produced by deuterium-deuterium (DD) and deuterium-tritium (DT) fusion reactions. The facility has been designed with the assistance of Monte Carlo calculations. Here, we present neutron measurements with multiple techniques for the characterization of the radiation field and dosimetry. Activation foils are used as a standard technique for passive measurements of neutron fluxes. Active detectors, like fission chambers, are used mainly as online neutron monitor. Diamond detectors are applied with the main purpose of high-resolution neutron spectroscopy. Scintillators are used as neutron monitors and spectrometers with the additional capability of neutron/gamma discrimination. The characterized neutron beams will be mainly applied for the testing of electronics. more...

This study examined and compared all-suture anchors with metallic anchors in the arthroscopic repair of small to medium supraspinatus tears; a multi-dimensional evaluation protocol assessed (i) clinical, (ii) ultrasonographical, and (iii) functional criteria at mid-term. more...

Technetium-99m is the workhorse of diagnostic nuclear medicine. The aim of the work is to analyze the technetium-99m patents since 2000 to photograph its innovation. QUESTEL’s ORBIT Intelligence system was used for the collection of technetium inventions disclosed in patents and patent applications in more than 96 countries in the period 2000–2022; 2768 patent documents were analyzed. Patent counting and analysis have shown that SPECT imaging using technetium-99m radiopharmaceuticals is still robust. The introduction of new technetium-99m radiopharmaceuticals into clinical routine goes beyond successful trials. In eastern economies, such as China and other emerging markets, patent applications are on the rise, while those in developed western countries are stagnating, with some exceptions for the United States. But despite the difficulties, academic and industrial research on these tracers remains essential for the development of nuclear medicine. more...

Background: Evidence on the efficacy of minimally invasive (MI) segmental resection of splenic flexure cancer (SFC) is not available, mostly due to the rarity of this tumor. This study aimed to determine the survival outcomes of MI and open treatment, and to investigate whether MI is noninferior to open procedure regarding short-term outcomes. Methods: This nationwide retrospective cohort study included all consecutive SFC segmental resections performed in 30 referral centers between 2006 and 2016. The primary endpoint assessing efficacy was the overall survival (OS). The secondary endpoints included cancer-specific mortality (CSM), recurrence rate (RR), short-term clinical outcomes (a composite of Clavien-Dindo > 2 complications and 30-day mortality), and pathological outcomes (a composite of lymph nodes removed ≧12, and proximal and distal free resection margins length ≧ 5 cm). For these composites, a 6% noninferiority margin was chosen based on clinical relevance estimate. Results : A total of 606 patients underwent either an open (208, 34.3%) or a MI (398, 65.7%) SFC segmental resection. At univariable analysis, OS and CSM were improved in the MI group (log-rank test p= 0.004 and Gray’s tests p= 0.004, respectively), while recurrences were comparable (Gray’s tests p= 0.434). Cox multivariable analysis did not support that OS and CSM were better in the MI group (p= 0.109 and p= 0.163, respectively). Successful pathological outcome, observed in 53.2% of open and 58.3% of MI resections, supported noninferiority (difference 5.1%; 1-sided 95%CI − 4.7% to ∞). Successful short-term clinical outcome was documented in 93.3% of Open and 93.0% of MI procedures, and supported noninferiority as well (difference − 0.3%; 1-sided 95%CI − 5.0% to ∞). Conclusions: Among patients with SFC, the minimally invasive approach met the criterion for noninferiority for postoperative complications and pathological outcomes, and was found to provide results of OS, CSM, and RR comparable to those of open resection. more...

This study assessed the potential for decreasing the environmental impact of the European road transport sector by exploiting biofuels. After processing available data on the actual trends of biofuels utilisation in the sector, laboratory and on-road tests were conducted to compare the emissions from a C-segment Euro 6d-TEMP passenger car fed with commercial reference petrol and three experimental petrol blends containing components of renewable origin. Through the Life Cycle Assessment methodology based on measurement data, the environmental impacts of the four fuels were compared with an average C-segment battery electric vehicle. Concerning a fossil petrol car, all the fuels slightly reduced the impact on climate change, while the battery electric vehicle performed best. For the remaining environmental impact categories, the picture was less straightforward. more...

The high voltage Padova test facility (HVPTF) is an experimental device for the study of HV insulation in vacuum, in support of the realization of the prototype of a neutral beam injector for International Thermonuclear Experimental Reactor (ITER), named megavolt ITER injector and concept advancement (MITICA). The facility investigates the physical phenomena underlying voltage holding in vacuum, in particular the mechanisms causing breakdowns and the electrode conditioning process. At HVPTF, inside a high vacuum chamber, two stainless steel electrodes, separated by a few centimeters gap, can achieve HV values for a maximum potential difference of 800 kV. During the voltage conditioning of the electrodes, current MicroDischarges (MDs) and high-energy X-rays are observed and analyzed. In this work, we present a characterization of the MD dynamics occurring during the conditioning process, with the aim to gain information on the reason of the growing difference between the current contributions measured by the two electrodes. The analysis will be performed due to two new X-rays detectors recently installed: an lutetium yttrium orthosilicate (LYSO) and a LaBr3(Ce) scintillating crystal. The new diagnostics indeed provide the fine dynamics of a single MD, recording energy and time of each single detected X-ray. In particular, we compare the MD dynamics at the beginning and at the end of the conditioning process and try to give a preliminary interpretation of the observations. more...

Abstract: Identifying similar materials (i.e., those sharing a certain property or feature) requires interoperable data of high quality. It also requires means to measure similarity. We demonstrate how a spectral fingerprint as a descriptor, combined with a similarity metric, can be used for establishing quantitative relationships between materials data, thereby serving multiple purposes. This concerns, for instance, the identification of materials exhibiting electronic properties similar to a chosen one. The same approach can be used for assessing uncertainty in data that potentially come from different sources. Selected examples show how to quantify differences between measured optical spectra or the impact of methodology and computational parameters on calculated properties, like the density of states or excitonic spectra. Moreover, combining the same fingerprint with a clustering approach allows us to explore materials spaces in view of finding (un)expected trends or patterns. In all cases, we provide physical reasoning behind the findings of the automatized assessment of data. Impact statement: To predict novel materials with desired properties, data-centric approaches are in the process of becoming an additional fundament of materials research. Prerequisite for their success are well-curated data. Ideally, one can make use of multiple data collections. Bringing data from different sources together, poses challenges on their interoperability which are routed in two out of the 4V of Big Data. These are the uncertainty of data quality (veracity) and the heterogeneity in form and meaning of the data (variety). To overcome this barrier, universal and interpretable measures must be established, which quantify differences between data that are supposed to have the same meaning. Here, we show how a spectral fingerprint in combination with a similarity metric can be used for assessing spectral properties of materials. Our approach allows for tracing back in computed as well as measured data, differences stemming from various aspects. It thus paves the way for automatized data-quality assessment toward interoperability. Based on this, in turn, materials exhibiting similar features can be identified. Graphical abstract: more...

A 5-y-old spayed female Golden Retriever dog was referred because of severe normocytic normochromic nonregenerative anemia and thrombocytopenia. Serum analysis revealed hyperproteinemia and monoclonal or oligoclonal gammopathy. Fine-needle aspiration of the spleen revealed a highly erythrophagocytic population of neoplastic round cells, morphologically suggestive of plasma cells. After euthanasia, histologic assessment of the spleen and liver revealed an erythrophagocytic round cell tumor. Immunohistochemical analysis of the tumor population was positive for MUM1p and negative for CD3, CD20, and Iba-1, confirming the plasma cell origin of the tumor. Erythrophagocytic multiple myeloma is a very rare neoplastic condition in dogs. more...

Background: During the last decade, the CHA2DS2-VASc score has been associated with adverse clinical outcomes in several cardiovascular (CV) and non-cardiovascular diseases beyond atrial fibrillation (AF). Whether the CHA2DS2-VASc score stratifies mortality risk in elderly patients with AF and without AF is not well established. Methods: All consecutive patients aged ≥ 75 yrs hospitalized due to heart failure (HF), between January 2020 and November 2020, were retrospectively enrolled. All patients underwent physical examination, blood tests, electrocardiography and conventional transthoracic echocardiography. Primary endpoint was all-cause mortality, while secondary endpoint was the composite of all-cause mortality + rehospitalizations for all causes over mid-term follow-up. Results: The study included 261 HF patients (86.3 ± 6.4 years, 60.5% females). 85 AF and 176 non-AF patients were separately analyzed. Compared to non-AF patients, those with AF had significantly higher CHA2DS2-VASc score (5.6 ± 1.4 vs 5.1 ± 1.4, p= 0.007) and lower ejection fraction (47.4 ± 16.5 vs 56.7 ± 15.1%, p&lt; 0.001). Mean follow-up was 1.7 ± 0.5 yrs. During follow-up, 96 patients died (58.3% due to CV causes) and 79 were rehospitalized (58.2% due to CV causes). CHA2DS2-VASc score was independently associated with all-cause mortality in whole study population (HR 1.61, 95% CI 1.36–1.92) and in both AF (HR 1.41, 95% CI 1.09–1.82) and non-AF patients (HR 1.84, 95% CI 1.40–2.40). CHA2DS2-VASc score also predicted the secondary endpoint in the same study groups. CHA2DS2-VASc score ≥ 5 was the best cut-off value for predicting both outcomes. Conclusion: At mid-term follow-up, a CHA2DS2-VASc score ≥ 5 predicts increased risk of all-cause mortality and re-hospitalizations for all causes in elderly HF patients, regardless of AF. more...

Phytoplasma strains were sporadically found in specimens of Hishimonus hamatus, Japananus hyalinusand Graphocephala fennahicaught during an entomological survey conducted in Southern Switzerland on the edges and woods surrounding cultivated vineyards in 2017. The subsequent molecular characterization of the pathogens allowed to identify them as strains strictly associated to Flavescence dorée, a serious European grapevine disease, transmitted from vine to vine by the leafhopper Scaphoideus titanus. In particular, M12 and M50 genotypes were found in H. hamatusand J. hyalinus, respectively, while G. fennahiharboured mixed phytoplasma genotypes with at least two different Flavescence dorée isolates. The potential importance of these findings in the frame of the Flavescence dorée epidemics in Europe is discussed. more...

Separation by flotation is one of the common technologies used during beneficiation stage in mining industry, aiming at concentrating valuable minerals for downstream refining stages. Currently a new froth flotation technology is being developed under FineFuture (FF) project, funded by the European Union Horizon 2020 research and innovation programme (grant agreement No 821265). If implemented, this technology can valorise fine mineral particles instead of discarding them as residues, nevertheless this does not necessarily ensure the sustainability of the technology. In this paper, the environmental sustainability of the new technology is addressed by showing goal and scope phase set-up of two life cycle assessments applied to two industrial partners of the project. Each company works on a different mineral and has a different beneficiation scheme. The goal of assessment is to compare the current production chains with the new one where FF technology is to be implemented to eventually evaluate which option is more sustainable for each company. Both case studies do not contain flotation unit in their current beneficiation system. The first is Grecian Magnesite whose main products are magnesite concentrates (MgCO3) and magnesia (MgO). The foreseen plan is to apply the new flotation technology either on residual fines (< 4 mm) from washing units in beneficiation which are currently discarded, or on low quality MgCO3concentrates (<90% MgCO3) after beneficiation stage to acquire higher concentrations of MgCO3. The second case study is Eramet for manganese (Mn) concentrate production. The objective is to apply the FF technology to tailings which are the discarded residues of manganese beneficiation process, yet they contain a considerable amount of Mn. The tailings are currently sent to storage ponds, but the future aim is to process them with FF technology to recover enriched slimes that contain high concentration of Mn before sending the rest to the ponds. more...

Purpose: To evaluate the possible influence of chest wall conformation on myocardial strain parameters in a cohort of mitral valve prolapse (MVP) patients with and without mitral annular disjunction (MAD). Methods: All consecutive middle-aged patients with MVP referred to our Outpatient Cardiology Clinic for performing two-dimensional (2D) transthoracic echocardiography (TTE) as part of work up for primary cardiovascular prevention between March 2018 and May 2022, were included into the study. All patients underwent clinic visit, physical examination, modified Haller index (MHI) assessment (the ratio of chest transverse diameter over the distance between sternum and spine) and conventional 2D-TTE implemented with speckle tracking analysis of left ventricular (LV) global longitudinal strain (GLS) and global circumferential strain (GCS). Independent predictors of MAD presence on 2D-TTE were assessed. Results: A total of 93 MVP patients (54.2 ± 16.4 yrs, 50.5% females) were prospectively analyzed. On 2D-TTE, 34.4% of MVP patients had MAD (7.3 ± 2.0 mm), whereas 65.6% did not. Compared to patients without MAD, those with MAD had: 1) significantly shorter antero-posterior (A-P) thoracic diameter (13.5 ± 1.2 vs 14.8 ± 1.3 cm, p &lt; 0.001); 2) significantly smaller cardiac chambers dimensions; 3) significantly increased prevalence of classic MVP (84.3 vs 44.3%, p &lt; 0.001); 4) significantly impaired LV-GLS (-17.2 ± 1.4 vs -19.4 ± 3.0%, p &lt; 0.001) and LV-GCS (-16.3 ± 4.1 vs -20.4 ± 4.9, p &lt; 0.001), despite similar LV ejection fraction (63.7 ± 4.2 vs 63.0 ± 3.9%, p = 0.42). A-P thoracic diameter (OR 0.25, 95%CI 0.10–0.82), classic MVP (OR 3.90, 95%CI 1.32–11.5) and mitral annular end-systolic A-P diameter (OR 2.76, 95%CI 1.54–4.92) were the main independent predictors of MAD. An A-P thoracic diameter ≤ 13.5 cm had 59% sensitivity and 84% specificity for predicting MAD presence (AUC = 0.81). In addition, MAD distance was strongly influenced by A-P thoracic diameter (r = − 0.96) and MHI (r = 0.87), but not by L-L thoracic diameter (r = 0.23). Finally, a strong inverse correlation between MHI and both LV-GLS and LV-GCS was demonstrated in MAD patients (r = − 0.94 and − 0.92, respectively), but not in those without (r = − 0.51 and − 0.50, respectively). Conclusions: A narrow A-P thoracic diameter is strongly associated with MAD presence and is a major determinant of the impairment in myocardial strain parameters in MAD patients, in both longitudinal and circumferential directions. more...

Somatic gain-of-function (GOF) mutations in phosphatidylinositol-4, 5-bisphosphate 3-kinase catalytic subunit alpha (PIK3CA), the catalytic subunit of phosphoinositide 3-kinase (PI3K), have been recently discovered in cerebral cavernous malformations (CCMs), raising the possibility that the activation of PI3K pathways is a possible universal regulator of vascular morphogenesis. However, there have been contradicting data presented among various groups and studies. To enhance the current understanding of vascular anomalies, it is essential to explore this possible relationship between altered PI3K signalling pathways and its influence on the pathogenesis of CCMs. GOF PIK3CA-mutants have been linked to overgrowth syndromes, allowing this group of disorders, resulting from somatic activating mutations in PIK3CA,to be collectively named as PIK3CA-related overgrowth spectrum disorders. This paper reviews and attempts to conceptualise the relationships and differences among clinical presentations, genotypic and phenotypic correlations and possible coexistence of PIK3CAand CCMmutations/phenotypes in CCM lesions. Finally, we present a model reflecting our hypothetical understanding of CCM pathogenesis based on a systematic review and conceptualisation of data obtained from other studies. more...

Despite much progress in improving graft outcome during cardiac transplantation, chronic allograft vasculopathy (CAV) remains an impediment to long-term graft survival. MicroRNAs (miRNAs) emerged as regulators of the immune response. Here, we aimed to examine the miRNA network involved in CAV. miRNA profiling of heart samples obtained from a murine model of CAV and from cardiac-transplanted patients with CAV demonstrated that miR-21 was most significantly expressed and was primarily localized to macrophages. Interestingly, macrophage depletion with clodronate did not significantly prolong allograft survival in mice, while conditional deletion of miR-21 in macrophages or the use of a specific miR-21 antagomir resulted in indefinite cardiac allograft survival and abrogated CAV. The immunophenotype, secretome, ability to phagocytose, migration, and antigen presentation of macrophages were unaffected by miR-21 targeting, while macrophage metabolism was reprogrammed, with a shift toward oxidative phosphorylation in naïve macrophages and with an inhibition of glycolysis in pro-inflammatory macrophages. The aforementioned effects resulted in an increase in M2-like macrophages, which could be reverted by the addition of L-arginine. RNA-seq analysis confirmed alterations in arginase-associated pathways associated with miR-21 antagonism. In conclusion, miR-21 is overexpressed in murine and human CAV, and its targeting delays CAV onset by reprogramming macrophages metabolism. more...

Atypical teratoid/rhabdoid tumors (ATRTs) are highly malignant embryonal tumors of the central nervous system with a dismal prognosis. Using a newly developed and validated patient-derived ATRT culture and xenograft model, alongside a panel of primary ATRT models, we found that ATRTs are selectively sensitive to the nucleoside analog gemcitabine. Gene expression and protein analyses indicate that gemcitabine treatment causes the degradation of sirtuin 1 (SIRT1), resulting in cell death through activation of nuclear factor κB (NF-κB) and p53. Furthermore, we discovered that gemcitabine-induced loss of SIRT1 results in a nucleus-to-cytoplasm translocation of the sonic hedgehog (SHH) signaling activator GLI2, explaining the observed additional gemcitabine sensitivity in SHH-subtype ATRT. Treatment of ATRT xenograft-bearing mice with gemcitabine resulted in a >30% increase in median survival and yielded long-term survivors in two independent patient-derived xenograft models. These findings demonstrate that ATRTs are highly sensitive to gemcitabine treatment and may form part of a future multimodal treatment strategy for ATRTs. more...

Background: Laparoscopic cholecystectomy is considered the gold standard for the treatment of gallbladder lithiasis; nevertheless, the incidence of bile duct injuries (BDI) is still high (0.3–0.8%) compared to open cholecystectomy (0.2%). In 1995, Strasbergintroduced the "Critical View of Safety" (CVS) to reduce the risk of BDI. Despite its widespread use, the scientific evidence supporting this technique to prevent BDI is controversial. Methods: Between March 2017 and March 2019, the data of patients submitted to laparoscopic cholecystectomy in 30 Italian surgical departments were collected on a national database. A survey was submitted to all members of Italian Digestive Pathology Society to obtain data on the preoperative workup, the surgical and postoperative management of patients and to judge, at the end of the procedure, if the isolation of the elements was performed according to the CVS. In the case of a declared critical view, iconographic documentation was obtained, finally reviewed by an external auditor. Results: Data from 604 patients were analysed. The study population was divided into two groups according to the evidence (Group A; n= 11) or absence (Group B; N= 593) of BDI and perioperative bleeding. Conclusions: The CVS confirmed to be the safest technique to recognize the elements of the Calottriangle and, if correctly performed, it significantly impacted on preventing intraoperative complications. Additional educational programs on the correct application of CVS in clinical practice would be desirable to avoid extreme conditions that may require additional procedures. more...

Introduction: Nowadays, reports of beriberi are rare in developed countries. Wernicke encephalopathy may be present in about 25% of patients with beriberi. Case report: We report the case of a woman with history of depression and chronic eating disorder, who complained Wernicke encephalopathy and beriberi. Sural nerve and muscular biopsy were performed, showing severe axonal neuropathy. Thiamine supplementation was started with rapid improvement of the pulmonary and cardiac affections; improvement of peripheral neuropathy was incomplete. Conclusions: Thiamine deficiency can be misdiagnosed. Beriberi is an important cause of acute flaccid paralysis; hence, clinicians should consider this diagnosis and prompt start thiamine treatment to avoid permanent neurological sequelae. more...

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Background: Controversy remains regarding the prevalence of hyperglycaemia in non-diabetic patients hospitalised with acute coronary syndrome and its prognostic value for long-term outcomes.Methods and results: We evaluated the prevalence of hyperglycaemia (defined as fasting glycaemia ⩾10 mmol/l) among patients with no known diabetes at the time of enrolment in the prospective Special Program University Medicine-Acute Coronary Syndromes cohort, as well as its impact on all-cause death, myocardial infarction, stroke and incidence of diabetes at one year. Among 3858 acute coronary syndrome patients enrolled between December 2009–December 2014, 709 (18.4%) had known diabetes, while 112 (3.6%) of non-diabetic patients had hyperglycaemia at admission. Compared with non-hyperglycaemic patients, hyperglycaemic individuals were more likely to present with ST-elevation myocardial infarction and acute heart failure. At discharge, hyperglycaemic patients were more frequently treated with glucose-lowering agents (8.9% vs 0.66%, p<0.001). At one-year, adjudicated all-cause death was significantly higher in non-diabetic patients presenting with hyperglycaemia compared with patients with no hyperglycaemia (5.4% vs 2.2%, p=0.041) and hyperglycaemia was a significant predictor of one-year mortality (adjusted hazard ratio 2.39, 95% confidence interval 1.03–5.56). Among patients with hyperglycaemia, 9.8% had developed diabetes at one-year, while the corresponding proportion among patients without hyperglycaemia was 1.8% (p<0.001). In multivariate analysis, hyperglycaemia at presentation predicted the onset of treated diabetes at one-year (odds ratio 4.15, 95% confidence interval 1.59–10.86; p=0.004).Conclusion: Among non-diabetic patients hospitalised with acute coronary syndrome, a fasting hyperglycaemia of ⩾10 mmol/l predicted one-year mortality and was associated with a four-fold increased risk of developing diabetes at one year. more...

Background: Exercise is recognized to evoke multisystemic adaptations that, particularly in obese subjects, reduce body weight, improve glucometabolic control, counteract sarcopenia, and lower the risk of cardiometabolic diseases. Understanding the molecular and cellular mechanisms of exercise-induced benefits is of great interest due to the therapeutic implications against obesity. Objectives and methods: The aim of the present study was to evaluate time-related changes in size distribution and cell origin of extracellular vesicles (EVs) in obese and normal-weight subjects who underwent a moderate-intensity exercise on a treadmill (at 60% of their VO2max). Blood samples were drawn before, immediately at the end of the exercise and during the postexercise recovery period (3 and 24 h). Circulating EVs were analyzed by a nanoparticle tracking analysis and flow cytometry after labeling with the following cell-specific markers: CD14 (monocyte/macrophage), CD61 (platelet), CD62E (activated endothelium), CD105 (total endothelium), SCGA (skeletal muscle), and FABP (adipose tissue). Results: In all subjects, acute exercise reduced the release of total (i.e., 30–700 nm) EVs in circulation, predominantly EVs in the microvesicle size range (i.e., 130–700 nm EVs). The postexercise release of microvesicles was higher in normal-weight than obese subjects; after exercise, circulating levels of exosomes (i.e., 30–130 nm EVs) and microvesicles were, respectively, lower and higher in females than males. In all experimental subgroups (males vs. females and obese vs. normal-weight subjects), acute exercise reduced and increased, respectively, CD61 + and SCGA + EVs, being the effect on CD61 + EVs prolonged up to 24 h after the end of the test with subjects in resting conditions. Total EVs, exosomes, and CD61 + EVs were associated with HOMA-IR. Conclusions: Though preliminary, the results of the present study show that a single bout of acute exercise modulates the release of EVs in circulation, which are tissue-, sex-, and BMI specific, suggesting that the exercise-related benefits might depend upon a complex interaction of tissue, endocrine, and metabolic factors. more...

This article provides an overview of the potentials and vast areas of digital applications in the field of sports medicine.Digital transformation is becoming increasingly common in modern life and sports medicine, like many other medical disciplines, it is strongly influenced and impacted by this rapidly changing field. This review aims to give a brief overview of the potential that digital technologies can have for health care providers and patients in the clinical practice of sports medicine. We will focus on mobile applications, wearables, smart devices, intelligent machines, telemedicine, artificial intelligence, big data, system interoperability, virtual reality, augmented reality, exergaming, or social networks. While some technologies are already used in current medical practice, others still have undiscovered potential. Due to the diversity and ever changing nature of this field, we will briefly review multiple areas in an attempt to give readers some general exposure to the landscape instead of a thorough, deep review of one topic. Further research will be necessary to show how digitalization applications could best be used for patient treatments. more...

Purpose: Post-craniotomy pain is a common clinical issue and its optimal management remains incompletely studied. Utilization of a regional scalp block has the potential advantage of reducing perioperative pain and opioid consumption, thereby facilitating optimal postoperative neurologic assessment. The purpose of this study was to assess the efficacy of regional scalp block on post-craniotomy pain and opioid consumption. Methods: We performed a prospective randomized-controlled trial in adults scheduled to undergo elective supratentorial craniotomy under general anesthesia to assess the efficacy of postoperative bilateral scalp block with 0.5% bupivacaine with 1:200,000 epinephrine compared with placebo on postoperative pain and opioid consumption. The primary outcome was the visual analogue scale (VAS) for pain at 24 hr postoperatively. Results: Eighty-nine patients were enrolled (n= 44 in block group; n= 45 in control group). There was no difference in the mean (standard deviation) VAS score at 24 hr postoperatively between the treatment group and the control group [31.2 (21.4) mm vs23.0 (19.2) mm, respectively; mean difference, 6.6; 95% confidence interval, -2.3, 15.5; P= 0.15]. There was also no significant difference in postoperative opioid consumption. Distribution of individual VAS score and opioid consumption revealed that postoperative pain was highly variable following craniotomy. Time to hospital discharge was not different between treatment and placebo groups. No adverse events associated with scalp block were identified. Conclusion: These data show that bilateral scalp blocks using bupivacaine with epinephrine did not reduce mean postoperative VAS score or overall opioid consumption at 24 hr nor the time-to-discharge from the postanesthesia care unit or from hospital. Trial registration: www.ClinicalTrials.gov, NCT00972790; registered 9 September, 2009. more...

Looks at Huntington's Disease and the genes that cause it. The discovery of Huntington's Disease and the mutated gene huntingtin; Explanations for why extra glutamines in a protein cause disease; Research by Scott Zeitlin of Columbia University on determining the function of normal huntingtin in the brain; Possible treatments for the disease. INSETS: Overview/Huntington's Disease;MOLECULAR BASIS OF HUNTINGTON'S. more...

The existence of an inverted U‐shaped effect of the relatedness between acquirer and acquired firm on the innovative performance subsequent to an acquisition is normally regarded as indicative of the existence of a trade‐off between exploration and exploitation in external innovation search. We argue that acquirers endowed with heterogeneous learning capabilities can alter the shape of the trade‐off to their favour. In particular, we focus on a notion of industry relatedness that captures the coherence between the domains of operation of the acquirer and the acquired firm. Using a longitudinal dataset of 1,736 domestic acquisitions in the Netherlands, we show that the heterogeneous learning capabilities of the acquirers alter the shape of the inverted‐U relationship, according to first‐ and second‐order moderating effects. Our results confirm that learning capabilities by internal R&D and by acquisition experience both improve what acquirers can achieve in innovative performance when industry relatedness is at the point of balance between exploration and exploitation. In contrast, they have opposite implications on the potential losses in innovative performance when industry relatedness is outside the point of balance: internal R&D increases the tolerance of the trade‐off, smoothing out potential innovation losses, whereas acquisition experience reduces it. more...

Copper treated tailings (TT) have been studied as a supplementary cementitious material from a mechanical performance point of view. Nevertheless, treatments on tailings introduces impacts that need to be considered when evaluating the environmental performances. This Life Cycle Assessment (LCA) study focusses on the use in concrete mixes of TT. Mixes were compared to concrete mixes without TT for three scenarios: equivalent compressive strength with same water-to-cementitious ratio, maximum compressive strength, and minimum allowable strength. Results show that in case of concrete mixes with higher mechanical performance, environmental impact indicators show better results than those of concrete mixes without tailings. more...

Re-use of packaging items plays a key role in the achievement of sustainable management of resources, one of the key aims of the circular economy concept. In this study, the environmental impacts of the life cycle of glass bottles used for mineral water have been assessed as a function of the number of uses (the so-called “rotations”) by applying the life cycle assessment (LCA) methodology. The research is part of a wider project on the evaluation of the environmental impacts and benefits associated with the re-use of packaging in Italy. The study has been performed to identify the contribution of the reconditioning process to the total impacts of the life cycle of reusable glass bottles and to compare the environmental performances of this system with those of a system based on single-use bottles. The production of the bottles, their washing and end of life have been included in the system boundaries, as well as the logistic for the delivery to the final user (that differs among the reusable and single-use bottles-based systems). The study was built up mainly on primary data acquired through a detailed inventory questionnaire delivered to some Italian mineral water companies that use reusable glass bottles, and complemented by field visits to two reconditioning plants. more...